Device for endoscopic examinations

ABSTRACT

A device for endoscopic examinations and operations includes a frame on which one or more of holding, connecting and receiving elements for locking and/or spreading instruments, lighting devices, liquid and/or gas suction devices, examination and/or surgical instruments may be arranged and detachably secured, as may also tongue and labial commissure retaining spatulas, palatal plates, lighting and receiving members for other devices and/or instruments.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The invention is directed towards a device for endoscopic examinationsand/or operations, in particular in the region of the epipharynx,oropharynx, mesopharynx and/or hypopharynx and/or of the larynx, butalso, in optionally modified form, for cardiosurgical, laparoscopic,neurosurgical and/or gynaecological examinations and/or operations.

2. Description of the Prior Art

In the aforementioned region of the pharynx and of the larynx a largenumber of pathological changes may occur which not uncommonly requiresurgical therapy. For instance, besides benign tumors, carcinomas occurof the pharynx, for example pharyngeal lymphoepithelioma, and of thelarynx, for example in the form of carcinoma of the sphenocephalus.Depending on the site of these tumors, a pharyngectomy or a laryngectomyis carried out in these cases. With a view to diagnosis of tumors in theregion of the pharynx, use is made of a so-called laryngoscope, anendoscope with a spatula for pressing the tongue against the floor ofthe mouth and also optionally a laryngeal spatula. With the aid of sucha laryngoscope it is also possible to operate by means of laser surgery,but both diagnosis and therapy prove difficult in many cases, forexample when a tumor is located in the valleculae; this difficultyresults from the tube diameter of such a laryngoscope. In the region ofthe transition from the oropharynx or mesopharynx to the hypopharynx,malignant tumors are to be found with increased incidence, the removalof which by laser surgery has hitherto been made decidedly difficult asa consequence of the intermittent use during surgery of instruments forrepresenting the corresponding anatomical region. Moreover, there are anumber of other problems, particularly in the region of the oropharynxand mesopharynx, which necessitate surgical intervention, for exampletonsillectomy. In all these cases it is possible in principle fordiagnosis and/or surgical intervention to be undertaken through thepharynx; however, on account of the convoluted structure thereof and thelimited capacity of a patient to open his mouth wide it is extremelydifficult to insert appropriate examining and/or surgical instruments asfar as the location in question.

Similar difficulties also arise within the scope of endoscopy-baseddiagnostic measures and/or of surgical therapies in the region of otherorgans of the body, for example in the case of cardiosurgery,laparoscopy, neurosurgery or gynaecology. Here too, the access path isoften very cramped, so that examinations and/or operations are greatlyimpeded.

This disadvantage of the known state of the art results in the problemthat gives rise to the invention, namely of creating a device with whichendoscopic examinations and/or operations, in particular in the regionof the pharynx and of the larynx, can be performed without thisentailing the need for a largely rigid instrument with a large tubecross-section, as is the case with conventional endoscopes, to be pushedforward as far as the location in question and without an operationhaving in certain circumstances to be carried out without direct view.Furthermore, there is a need for enlargement of the access path and fordynamic regulation of all anatomical areas of the region in question inorder that the operation may become more precise and thereby safer.

SUMMARY OF THE INVENTION

The solution to this problem is achieved in the case of a generic deviceby virtue of a design according to the invention as described in themain claim. The core of the device according to the invention is formedby a rigid framework which, for example, can be fixed with a chestsupport and which serves to attach a plurality of instruments, inparticular locking and spreading instruments for holding the mouth open,such as lingual and labial-commissure spatulas and also, in certaincircumstances, a palatal plate, for auxiliary instruments such aslighting and suction devices, for examining instruments such aslaryngoscopes and also for surgical instruments such as forceps andscalpels for tonsillectomy or for instruments for laser surgery. Bymeans of the palatal plate according to the invention the mouth of apatient can be pushed wide apart, a lingual spatula presses the tonguelargely out of the field of view and can, in certain circumstances, becombined with a laryngeal spatula which induces raising of theepiglottis and thereby opens the larynx. Labial-commissure spatulasspread the buccae apart laterally in order to create an access for aidsand instruments that is as wide as possible. By way of aids, use may bemade in particular of lighting means, suction devices or the like whichcreate optimal conditions for a diagnosis or an operation. Finally, theexamining and/or surgical instruments can be moveably secured to theframework according to the invention, in order on the one hand tostabilise their position and on the other hand to make exact movementspossible. By this means the precision of an intervention can beincreased, so that the burden on a patient is reduced.

For holding a plurality of aids and/or instruments use is made of one ormore elongated, stable frame-elements, on which the means and/orinstruments in question can be clamped or displaced. In a preferredembodiment two such attachment frame-elements are present which areapproximately parallel to one another, which exhibit a spacing of about5 to 10 cm and which, during use, extend approximately parallel to thebuccae of a patient. These frame-elements serve, inter alia, to clampfirmly one labial-commissure spatula each; in order in this connectionto be able to accommodate in positive manner the forces arising in thecourse of a spreading-out movement, the attachment frame-elements, onwhich the approximately sleeve-shaped holding parts for alabial-commissure spatula are pushed in positive manner, are providedwith a polygonal cross-section, in particular a square cross-section.

These two attachment frame-elements are connected to one another bymeans of a crosspiece, located approximately in the region of the mentumof a patient, so as to form a preferably U-shaped, optionally alsorounded or rectangular, attachment framework and/or attachment frame. Inorder to be able to adapt this framework to the oral width and themandibular width of a patient, the attachment frame-elements may bedesigned to be adjustable in relation to the crosspiece about axes ofrotation which extend perpendicular to the base surface of the U-shapedattachment framework. This possibility of adjustment can, for example,be brought about by means of a screw-clamp mechanism having a clampscrew that functions at the same time as a swivel joint.

The crosspiece of the U-shaped attachment framework additionally bears areceiving means for a lingual spatula and also a connecting element fora chest support. This receiving means for the lingual spatula isarranged in such a way that the longitudinal axis of the lingual spatulaextends approximately perpendicular to the base plane of the U-shapedattachment framework, so that the attachment frame-elements extend closeto the buccae of a patient.

In a first embodiment, which resembles the basic form of a conventionallaryngoscope, the receptacle for a lingual spatula is arranged rigidlyon the crosspiece. In this case the mouth can be opened by tilting backthe head of a patient lying on his dorsum, so that a palatal plate isnot absolutely essential. In practice, however, an arrangement hasproved useful in which the receiving means for the lingual spatula isdisplaceable in relation to the crosspiece along an axis which isapproximately parallel to the attachment frame-elements. Thisarrangement is suitable in particular for a further development of theinvention, wherein on the free ends of the attachment frame-elementslocated opposite the crosspiece a transverse frame-element is arrangedhaving a plate which is applied to the palate of a patient and therebydefines the position of the U-shaped attachment framework. If thereceiving means for the lingual spatula is now displaced in relation tothe crosspiece, then the mandible of a patient opens in the process,resulting in a functionally reliable mouth gag. In order to make suchadjustability possible, the receiving means for the lingual spatula isarranged at the upper end of a column which passes through a guideelement of the crosspiece and may simultaneously be provided at itslower end with a connecting element for a chest support. With the aid oftransmission mechanisms, both adjustment and locking of the column thatbears the lingual spatula can be brought about.

A possibility of adjustment may be provided, in order to be able toadapt the effective length of the lingual spatula projecting into thepharynx to a patient. To this-end the handle part of the lingual spatulamay be received in a guide profile, it being possible for thedisplacement position of the spatula to be preset with an adjustingscrew.

The invention makes use of lingual spatulas that have been expresslydesigned for this attachment framework; said spatulas are distinguishedby an approximately spoon-type tongue part and, adjacent thereto, astraight holding part which is not inclined or only slightly inclined inrelation to the tongue part, the entire lingual spatula being producedfrom a rigid and solid material, for example a sheet of stainless steel2.5 mm thick, in particular being stamped out and bent. For the purposeof longitudinal adjustment the holding part is constructed with aconstant cross-section and comprises on its underside a row of teethformed by milled notches extending transversely, with which an adjustingtoothed wheel of the receiving means described above can engage. Thelower part of the spoon-type tongue part may be provided with afriction-augmenting profile. Furthermore, different shapes of thespoon-type tongue part are possible: in a standard design the latter isalmost completely plane and inclined by only a few degrees in relationto the rear holding part. In a second embodiment the tongue part may becurved towards the underside in the manner of an arch, similarly to thelaryngeal spatula of a conventional laryngoscope, so that the free endof the tongue part forms with the holding part an angle of about 15 to25°. Furthermore it is possible, departing from the spoon shape, toprovide a lateral cut-out on one or both sides of the tongue part inorder to permit examinations and/or operations in the regions exposed byit. In addition it is possible to impress a curvature on the tongue partin the transverse direction in such a way that the lateral regions ofthe tongue part recede upwards and injuries to the tongue are avoided.

The palatal plate already referred to above for the support of thepalate of a patient is provided, according to the invention, with aframe-element having bushings arranged at its ends, each of which can bepushed onto a free end of the U-shaped attachment framework as far as astop element arranged there. For the purpose of receiving the dentesincisivi and/or the alveolar crest of the maxilla the palatal plate maybe curved continuously downwards in its longitudinal direction inconcave manner or in the form of a saddle.

The labial-commissure spatulas provided by the inventors for lateralspreading of the buccae have an elongated, narrow basic form. With aview to avoiding injuries to the patient, the front edge of suchlabial-commissure spatulas is rounded and such a spatula consistsmoreover of a material of limited elasticity, for example a softmetallic sheet having a thickness of 1.5 to 2 mm. For the purpose ofsetting the spreading angle of such labial-commissure spatulas, use ismade of the attachment element thereof, which for this purpose isprovided with an articulation means and/or adjusting means. Suchlabial-commissure spatulas may also be used for spreading the lateralwall of the hypopharynx. A labial-commissure spatula is inserted in thisregion by being pushed further forward in its guide in the direction ofthe hypopharynx and provides valuable assistance there to the extentthat the sinus piriformis, in which about 90% of all carcinomas of thehypopharynx originate, is held open during the operation.

According to the invention a lighting means is further provided whichmay be formed from a system of lenses with a rear screw connection for afibre-optic cable and which is connected by means of a ball-and-socketjoint arranged on the casing of this element to a clip with a view tofirm clamping to one of the two attachment frame-elements. A similarclip may comprise, instead of the lighting-means and/or ball-and-socketjoint, a second attachment clip in which, for example, a suction tube oran instrument can be inserted and firmly clamped.

BRIEF DESCRIPTION OF THE DRAWINGS

Further particulars, features and advantages on the basis of theinvention result from the following description of a preferredembodiment example of the invention and also by reference to thedrawing. The latter shows in:

FIG. 1 an axonometric view of a device according to the invention,partly disassembled;

FIG. 2 a side view of FIG. 1 in the direction of arrow II, partly insection;

FIG. 3 the underside of the lingual spatula detached from the deviceaccording to FIGS. 1 and 2;

FIGS. 4a, 4b other lingual spatulas with differing shape of the tonguepart in a representation corresponding to FIG. 2;

FIG. 5 a lingual spatula that is slightly modified in comparison withFIGS. 3 to 4b, in side view;

FIG. 6 another lingual spatula according to the invention, in top view;

FIG. 7 a side view of the lingual spatula from FIG. 6;

FIG. 8 an axonometric representation of the left labial-commissurespatula from FIG. 1 on an enlarged scale, so that the receiving andspreading means can be identified more clearly;

FIG. 9 a top view of FIG. 8 in the direction of arrow IX;

FIG. 10 a side view of the receiving means of FIG. 8 in the direction ofarrow X;

FIG. 11 another receiving means for securing an instrument to the deviceaccording to the invention, in an axonometric representation;

FIG. 12 a top view of FIG. 11 in the direction of arrow XII, partly insection; and

FIG. 13 a side view of the receiving means from FIG. 11 in the directionof arrow XIII.

DETAILED DESCRIPTION OF THE INVENTION

In FIG. 1 a supporting epi-oro-hypopharyngo-laryngoscope 1 isrepresented with a plurality of appended aids and instruments. With aview to promoting comprehension at a glance, reference will thereforefirstly be made to FIG. 2, in which the majority of the appended partshave been omitted so that the actual framework 2 of thepharyngo-laryngoscope 1 according to the invention can be discerned moreclearly. The framework 2 comprises two frame-elements 3a, 3b which havea constant, approximately square cross-section. These two frame-elements3a, 3b are slightly curved with a radius of curvature of about 25 to 40cm and are connected at their lower ends 4 by means of a screwed-on 5transverse frame-element 6 so as to form a plane, approximately U-shapedframework 2. The attachment screws 5 in question are arranged on thetransverse frame-element 6 in such a way that the free upper ends 7 ofthe two frame-elements 3a, 3b extend approximately parallel to oneanother, whereas the lower ends 4 converge towards one another by reasonof the curved shape. This inherently rigid framework 2 of thepharyngo-laryngoscope 1 according to the invention serves to fix aplurality of locking, spreading and auxiliary means, examininginstruments and surgical instruments as well as a connecting element fora chest support.

The palatal plate 8 which has been removed in FIG. 2 but which is shownmounted in FIG. 1 has an approximately circular base surface, which inits longitudinal direction is curved approximately in the form of asaddle, and serves to support the rear region of the hard palate and/orof the processus alveolaris maxillae or of the dentes incisivi.

This palatal plate 8 is stamped, together with a transverseframe-element 9 adjacent to the front edge of said palatal plate, froman approximately 2.5 mm thick sheet of stainless steel and is thereforestable enough to be able to transmit, without causing deformation, theforces that are necessary for locking the maxilla open. In its lateralregion the transverse frame-element 9 is spaced, for instance, from themedian plane by a distance corresponding to half the width of thepalatal plate 8, cranked upwards 10 by an extent amounting to about 1cm, so that in the distal regions 11 of the transverse frame-element 9the cavitas oris propria is optimally accessible below the processusalveolaris maxillae and also, in certain circumstances, below the dentesincisivi. At the free ends of the distal regions 11 a sleeve-shapedattachment element 12 is then arranged in each case, in particular it iswelded on. These attachment sleeves 12 have a square internalcross-section corresponding approximately to the cross-section of theattachment frame-elements 3a, 3b, and the spacing between the twosleeves 12 that is determined by the proximal part and the two distalparts 11 of the crosspiece 9 corresponds to the spacing between the twoupper ends 7 of the two transverse frame-elements 3a, 3b, so that thepalatal plate 8 with these sleeves 12 can be attached onto the U-shapedattachment framework. Each of the two attachment frame-elements 3a, 3bcomprises, at a spacing of about 1 cm below its upper end face 13, aprolongation 14 projecting approximately horizontally which serves as astop for the sleeves 12 and prevents the palatal plate 8 from slidingdown along the attachment frame-elements 3a, 3b. The longitudinal axesof the two sleeves 12 extend approximately perpendicular to the basesurface of the palatal plate 8.

In its capacity as locking device the palatal plate 8 finds itscomplement in a lingual spatula 15, with which the tongue is pressedagainst the floor of the mouth and at the same time the mandible is, asa result, locked open in a downward direction. As can be discerned inFIGS. 2 and 3, the lingual spatula 15 has a flat, almost plane shapehaving approximately the outline of a spoon. The front or tongue part 16is located with its underside 17 in contact with the tongue of thepatient, whereas the rear, stalk-shaped region 18 is retained on theU-shaped attachment framework 2. With a view to attaching thepharyngo-laryngoscope 1 according to the invention, the spacing betweenthe palatal plate 8 and the lingual spatula 15 can firstly be reduced;thereafter the spacing is increased in order to lock the oral cavityopen. This displacement movement 19 of the lingual spatula 15approximately perpendicular to the underside 17 thereof is achieved bythe receiving means 20 for the lingual spatula 15 being arranged on acolumn 21 which is longitudinally displaceable within a sleeve 22. Thissleeve 22 is firmly screwed 7 to the crosspiece 6 in such a way that itslongitudinal axis and hence also the column 21 extends in the medialplane of the U-shaped attachment framework 2 and also approximatelyparallel to the two attachment frame-elements 3a, 3b. In reality thebase plane of the U-shaped attachment framework 2 is inclined by anangle of about 10° in relation to the longitudinal axis of the column 21in order at least partly to compensate for the receding of the hardpalate in relation to the tongue of the patient during dorsal flexion ofthe cranium by means of an approximately secant-like orientation of theU-shaped framework 2.

With a view to locking the column 21 in any displacement position inrelation to the sleeve-shaped holder 22, on the side 23 of the column 21facing the crosspiece 6 a longitudinal slot 24 is provided which ispenetrated by the shank of a screw 26 that is provided with a knurledhead 25, said screw being moreover inserted into a bore in thecrosspiece 6 and also in the region of the sleeve-shaped element 22adjacent thereto. This screw is screwed within an approximatelycylindrical clamping element which is located within the column 21 andwhich in the case where the screw 26 is locked onto the front region 23of the column 21 is applied thereto in order to bring about fixation ofthe column by frictional engagement. Prior to the locking of the column21 in any intermediate position a defined possibility for adjustment 19is important in order to be able to lock the oral cavity open in gentleyet vigorous manner. A second knurled screw 27 which penetrates alateral bore in the column 21 is provided for this purpose. However,this screw is provided on its shank not with a thread, as is generallyconventional, but with a pinion-type toothed profile 115 which mesheswith a toothed rack 28 arranged within the column 21. This toothed rack28 is connected in non-displaceable manner to the aforementionedcylindrical clamping part which is pressed by the screw 26 for thepurpose of locking onto the front 23 inner side 29 of the column 21, sothat by displacement of the toothed rack 28 as a consequence of arotation 30 of the knurled adjusting screw 27 when the locking screw 26is loosened also the cylindrical clamping part and hence also the guidepart 22 is displaced 19 together with the crosspiece 6 in relation tothe column 21. It, accordingly, the knurled screw 27 according to FIG. 2is rotated 30 clockwise, the column 21 travels 19 downwards in relationto the U-shaped framework 2, which is equivalent to raising the palatalplate 8 in relation to the lingual spatula 15 and to locking the oralcavity of the patient open.

Since in this regard the spacing of the mandible in relation to thethorax barely changes, a chest support may be connected to the lower end31 of the column 21. This column end 31 comprises for this purpose abushing-like hollow 32 with an inner, peripheral stop shoulder 33 andalso an axially parallel notch 34. This receptacle 32 corresponds to thestandard peg of commercially available chest supports, the notch 34serving to insert a clamp screw that is screwed on within the peg of thechest support. Conventional chest supports are in fact usually equippedwith an adjustable articulation so that adaptation to the particularapplication is possible. The capacity for adjustment of such anarticulation, however, is often limited, since such supports areoptimized for the connection to conventional and hence differentlydesigned laryngoscopes. In order to compensate here for any differencein angle that may arise, the invention provides an angle piece 36 whichcomprises a peg 35 for the purpose of insertion into the bushing 32, onthe one hand, and also a bushing element 37 for the purpose ofconnection to the chest support, on the other hand. These two parts 35,37 of the angle piece 36 form an angle of about 140°. A lateralprolongation 38 of the peg 35 engages the notch 34 of the bushing 32 ofthe pharyngo-laryngoscope 1 according to the invention and therebyavoids twisting of the angle piece 36. Arranged diametrally opposite theprolongation 38 is a spring-mounted ball 39 for producing a frictionalengagement between the peg 35 and the bushing 32.

Prior to the oral cavity being locked open it is firstly necessary toadjust the length of the lingual spatula 15 to the patient in question.For this purpose the lingual spatula 15 is displaceably received 40 inthe receptacle 20 along its longitudinal axis. To this end the receivingmeans 20 is constructed as a rail that grips the spatula handle 18 frombelow, grips round it and grips it at least partly from above, said railhaving a constant profile cross-section that is shaped to beapproximately complementary to the cross-section of the spatula handle18. With a view to adjustment 40, a knurled screw 41 is actuated 42, theaxis of rotation 43 of which penetrates the receiving part 20approximately parallel to the rosspiece 6. The shank 43 has, moreover, alength that is greater than one half of the spacing between the twotransverse frame-elements 3a, 3b, so that the knurled screw 41 liesoutside the oral region of a patient and can be actuated conveniently.The part of the screw means 41 located within the receiving means 20 isprofiled in the form of a pinion 116 and meshes with a row of teeth 44which is produced by milling on the underside 17 of the spatula handle18. By means of this transmission mechanism the rotary movement 42 ofthe knurled screw 41 is converted directly into a longitudinaldisplacement 40 of the lingual spatula 15 which can thereby be optimallyadapted to a patient. The lingual spatula 15 is not locked in itslongitudinal direction 40, so that when the oral cavity is locked open19 the spatula 15 can adapt itself to the anatomy of the patient. A stopprolongation 114 avoids jamming of the widened tongue part 16 in thereceiving means 20. In order to ensure in this connection that no offsetarises between the lingual spatula 15 and the tongue, the underside 17of the tongue part 16 of the spatula 15 is provided with a grid-type orchequerboard-type profile 45.

Further embodiments of lingual spatulas are represented in FIGS. 4 to 7.Here the spatulas 46a, 46b according to FIGS. 4a, 4b correspond largelyto the lingual spatula 15 according to FIG. 3, with the exception thatthe tongue part 47a, 47b is provided on its right and left sidesrespectively with a cut-out 48a, 48b in order to expose certain parts ofthe tongue for diagnostic and/or surgical purposes. In FIG. 5 a furtherembodiment 49 of a lingual spatula can be seen which may have the basicshape either of the spatula 15 or of a spatula 46a, 46b. Here, however,the tongue part 50 is provided with a longitudinal curvature leadingdownwards so that the rear region of the tongue is pressed against thehyoid bone in order to create optimal access to the larynx.

A similar longitudinal curvature is also exhibited by the tongue part 51of the lingual spatula 52 represented in FIGS. 6 and 7. The latter isformed, as it were, by a combination of the two lingual spatulas 46a,46b with a relatively narrow tongue part 51 which is barely wider thanthe handle 53. The underside 54 of the tongue part 51 is furthermorecurved in convex manner in the transverse direction in order that theedges 55 of the tongue part 51 do not cut into the tongue.

If the oral cavity is locked open in such a way by means of the palatalplate 8 and a lingual spatula 15, the buccae of the patient can bespread out laterally. Two labial-commissure spatulas 56a, 56b, the leftone 56a of which is represented on an enlarged scale in FIG. 8, servethis purpose. It can be discerned that each of the two labial-commissurespatulas consists of a flexible metal sheet having a thickness of about2 mm and has a length of about 20 to 25 cm. The front region 57 isprovided with a rounded edge 58 and also with a profile 59 on theoutside 60.

For the purpose of fixing and spreading apart these labial-commissurespatulas 56a, 56b, use is made in each case of a receiving means 61a,61b which is provided with a sleeve 62 of the same geometry as thesleeve 12 of the palatal plate 8. This sleeve 62 is pushed onto each ofthe two attachment frame-elements 3a, 3b--to be specific below the stopprolongation 14 thereof--so that these receiving means 61a, 61b are heldin captive manner on the U-shaped framework 2.

The labial-commissure spatula 56a is inserted into a slot 63 in thereceiving means 61a so that the flat, profiled 59 outside 60 of thelabial-commissure spatula 56a is oriented parallel to the relevant buccaof the patient, and is fixed in this position by a spring-mounted ball64. The length of the labial-commissure spatula 56a engaging within theoral cavity can be adjusted by displacement within the slot 63. For thepurpose of spreading apart the two labial-commissure spatulas 56a, 56b,use is made of an axis of rotation 65 which is parallel to thelongitudinal axis of the attachment frame-element 3a, 3b in question,said axis of rotation connecting the sleeve 62 of the receiving means61a in articulated manner to the slotted 63 part 66 of the receivingmeans 61a.

The articulation 65 permits the front region 57 of the labial-commissurespatula 56a in question to be spread apart 67; for the purpose of exactadjustment of the spreading angle 67, use is made of an additionalknurled screw 68 which is screwed into a threaded bore in a rear,flap-type prolongation 69 of the sleeve 62. The front end face 70 of thescrew shank 71 presses against the slotted part 66 so that the rotaryadjustment 72 of the knurled screw 68 is converted into a swivellingmovement 73 of the slotted receiving part 66 about the axis of rotation65 and finally results in the labial-commissure spatula 56a in questionbeing spread apart 67.

In order with the aid of knurled screw 68 also to be able to cause thetwo labial-commissure spatulas 56a, 56b to swivel together, in theregion of the front end face 70 of the screw shank 71 a circular disk 74is molded on which is partly gripped from the rear by two undercuts 75,76 of the slotted part 66 which are parallel to one another. Between thetwo undercuts 75, 76 a slot remains for passage of the screw shank 71.Depending on the rotary movement 72 of the knurled screw 68, thereforeeither the front end face 70 thereof presses against the bottom 77 ofthe undercut region (spreading-apart 67) or the circular disk 74 pullsthe slotted part 66 against the flap-type prolongation 69 via theundercuts 75, 76, whereby the front region 57 of the labial-commissurespatula 56a is swivelled towards the median plane of the patient.

After the oral cavity has been locked open and the buccae of a patienthave been spread apart in such a way, it is possible to provide forillumination of the pharynx. To this end the physician makes use of alighting means 78 that has been specially designed to be appended to theattachment framework 2 according to the invention and is represented inFIG. 1. Said lighting means consists of a cylindrical socket 79, intowhich a system of lenses is pressed. Screwed on a rear threadprolongation of the socket 79 is an adapter 80 which has approximatelythe shape of a cylindrical sheath and is provided on its rear end face81 with a special connecting thread 82 for screwing on a connectingelement of a fibre-optic cable which is not represented in FIG. 1.Arranged on the socket part 79 is an attachment block 83 which acquiresits approximately U-shaped form by virtue of a slot 84. The slot 84 hasapproximately the cross-section of an attachment frame-element 3a, 3b,so that the lighting means 78 can optionally be firmly clamped to bothframe-elements 3a, 3b. For the purpose of locking, use is made of aspring-mounted ball which cannot be discerned in FIG. 1, 25 said ballbeing similar to the ball 39 of the angle part 36 or the ball 64 of thereceiving means 61a. Furthermore, a ball-and-socket joint 85 is providedbetween the socket 79 and the attachment block 83, in order that theluminous cone of the lighting means 78 can be adjusted exactly.

An examination or operation can now be undertaken in the region of thepharynx or of the larynx. In the course of an operation, atumor-grasping forceps 86 is often required, such as is also representedin FIG. 1. Said grasping forceps consists of a hollow tube 87 in which arod 88 is inserted in telescopic manner which at its front end issubdivided in the axial direction and is also spread apart radially soas to form several pincer-like gripping elements 89. Arranged betweenthe rear ends of the telescopic tube 87 and also of the telescopic rod88 is a leaf spring 90 bent in the form of a U which, on the one hand,closes the grasping elements 89 of the forceps 86 automatically and, onthe other hand, serves as a handle.

In order to be able to work accurately with such a grasping forceps 86,the latter is also secured to a point on the attachment framework 2. Tothis end use is made of an additional standard receiving means 91represented in FIGS. 11 to 13. Said standard receiving means consists ofan attachment block 92 for securing to one of the two attachmentframe-elements 3a, 3b, which is identical with the attachment block 83of the lighting means 78. In particular in FIG. 12 it is possible todiscern the slot 93 for the purpose of firm clamping to an attachmentframe-element 3a, 3b and also the spring-mounted 94 ball 95 for thepurpose of locking by frictional engagement. Finally, molded in the yokeregion 96 of the cross-sectionally U-shaped attachment block 92 is thesocket 97 of a ball-and-socket joint 98, the ball 99 of which isconnected to the actual receiving block 100. As can be gathered fromFIG. 13, the receiving block 100 is provided on its side locatedopposite the ball 99 with a slot 101 for insertion of the telescopictube 87 of the tumor-grasping forceps 86. A leaf spring 103 firmlyscrewed 102 to the receiving block 100 springs radially into thereceiving slot 101 and thereby secures the telescopic tube 87 within theslot 101. The tumor-grasping forceps 86 is thereby self-locking in everyposition and yet can be displaced in the longitudinal direction withinthe slot 101 and can in addition be swivelled about the ball-and-socketjoint 98.

In a manner similar to that in the case of the tumor-grasping forceps86, a plurality of additional examining and/or surgical instruments mayalso be inserted in a standard receiving means 91, in particular also aninstrument for laser surgery or laser coagulation of course, with suchsurgical laser interventions an intense generation of smoke occurs whichhinders the view and which could thereby nullify many of the advantagesof the pharyngo-laryngoscope 1 according to the invention. Therefore theinvention further provides a smoke-suction device 104 as represented inFIG. 1. Said smoke-suction device comprises a tubular piece 105 thatprojects into the oral cavity, on the front end of which is pushed agently curved sleeve 107 provided with perforations 106 with a view toavoiding injuries. The tube 105 is stiffened by means of an insertedand/or infused metallic wire and is attached by its rear end onto anelbow 108 which is provided at its rear end 109 with a tube-connectingpiece 110 for the purpose of pushing on a rubber tube that is connectedto a suction device. This connecting piece 110 tapers in approximatelyconical manner towards its free end in order to enable rubber tubes ofvariable cross-section to be pushed on. Furthermore, this connectingpiece 110 is provided on its outside with peripheral beads in order toprevent a rubber tube that has been pushed on from sliding down.

For the purpose of clamping such a suction device 104 firmly, use ismade of a receiving means 111 which comprises, in a manner similar tothe standard receiving means 91, an attachment block 112 for the purposeof clamping on one of the two attachment frame-elements 3a, 3b, onwhich, however, a slotted receiving block 113 is rigidly molded--ie,without a ball-and-socket joint.

What is claimed is:
 1. A device (1) for endoscopic examinations and operations, comprising a framework (2) and at least one of holding means (32), connecting means (12; 83) and receiving means (20; 61a, 61b; 91; 111), for locking elements, spreading elements (8), lingual spatulas (15; 46a, 46b; 49; 52), labial-commissure spatulas (56a, 56b), lighting means (78), suction devices (104) for, fluids including smoke, examining instruments, including endoscopes, surgical instruments, including grasping forceps (86) and laser instruments for laser surgery and laser coagulation, wherein said holding means (32), connecting means (12; 83) and receiving means (20; 61a, 61b; 91; 111 ) are arranged on the framework (2); anda toothed rack (28) with which the position of a column (21) bearing the receiving means (20) for the lingual spatula (15) is manually adjustable in relation to a guide element (22) of the attachment framework (2).
 2. The device as claimed in claim 1, wherein two stable frame-elements (3a, 3b) approximately parallel to one another are present on the attachment framework (2) for the purpose of securing displaceable connecting means (12; 83), receiving means (61a, 61b; 91; 111), for labial-commissure spatulas (56a, 56b), lighting means (78), suction devices (104), examining instruments and surgical instruments (86).
 3. The device as claimed in claim 2, wherein the attachment frame-elements (3a, 3b) have a square cross-section.
 4. The device as claimed in claim 2, wherein the two attachment frame-elements (3a, 3b) are connected to one another by means of a crosspiece so as to form a substantially U-shaped attachment framework (2).
 5. The device as claimed in claim 4, wherein the attachment frame-elements (3a, 3b) are displaceable in relation to the crosspiece (6) about axes of rotation that extend perpendicular to the base surface of the U-shaped attachment framework (2).
 6. The device as claimed in claim 4, wherein at least one of said receiving means (20; for one of a lingual spatula (15) and a chest support, and are arranged on the crosspiece (6) of the attachment framework (2).
 7. The device as claimed in claim 6, wherein the receiving means (20) is for the lingual spatula (15) and is arranged such that a longitudinal axis of the lingual spatula (15) extends substantially perpendicular to a base plane of the U-shaped attachment framework (2).
 8. The device as claimed in claim 7, wherein the receiving means (20) for the lingual spatula (15) is displaceable in relation to the crosspiece (6) along an axis (21) which is substantially perpendicular to the attachment frame-elements (3a, 3b).
 9. The device as claimed in claim 8, wherein the receiving means (20) for the lingual spatula (15) is arranged at one end of a column (21) which is guided displaceably (19) in a tube-shaped guide element (22) of the crosspiece (6).
 10. The device as claimed in claim 9, wherein the guide element (22) for the column (21) bearing the lingual spatula (15) is arranged in a substantially centric manner on the crosspiece (6) of the U-shaped attachment framework (2) so that the attachment framework (2) together with the column (21) forms shape of one of a Y and a trident.
 11. The device as claimed in claim 9, comprising a device (25, 26) for locking the column (21) bearing the receiving means (20) for the lingual spatula (15) in relation to the guide element (22) of the attachment framework (2).
 12. The device as claimed in claim 6, wherein the receiving means (20) for the lingual spatula (15) permits a displacement (40) of the spatula in its longitudinal direction.
 13. The device as claimed in claim 12, wherein the receiving means (20) for the lingual spatula (15) comprises a guide profile surrounding the handle (18) of said lingual spatula at least partly.
 14. The device as claimed claim 6, wherein the connecting means for a chest support is connected to the crosspiece (6) of the attachment framework (2) via a prolongation which extends substantially perpendicular to the longitudinal axis of the lingual spatula (15).
 15. The device as claimed in claim 14, wherein the connecting means for the chest support is arranged on an end face of the longitudinally displaceable column (21) located opposite the receiving means (20) for the lingual spatula (15).
 16. The device as claimed in claim 14, wherein the connecting means for the chest support comprises a hollow cylindrical bushing (32).
 17. A device (1) for endoscopic examinations and operations, said device comprising a framework (2) and at least one of holding means (32), connecting means (12; 83) and receiving means (20; 61a, 61b; 91; 111), for locking elements, spreading elements, lingual spatulas (15; 46a, 46b, 49; 52), labial-commissure spatulas (56a, 56b), lighting means (78), suction devices (104) for fluids, including smoke, examining instruments, including endoscopes, surgical instruments, including grasping forceps (86) and laser instruments for laser surgery and laser coagulation, wherein said holding means (32), connecting means (12; 83) and receiving means (20; 61a, 61b; 91; 111) are arranged on the framework (2), and a screw mechanism (41), for at least one of adjustment and locking of a displacement position (40) of the lingual spatula (15) in relation to the receiving device (20).
 18. A device (1) for endoscopic examinations and operations, said device comprising a framework (2) and at least one of holding means (32), connecting means (12; 83) and receiving means (20; 61a, 61b; 91; 111), for locking elements, spreading elements, lingual spatulas (15; 46a, 46b, 49; 52), labial-commissure spatulas (56a, 56b), lighting means (78), suction devices (104) for fluids, including smoke, examining instruments, including endoscopes, surgical instruments, including grasping forceps (86) and laser instruments for laser surgery and laser coagulation, wherein said holding means (32), connecting means (12; 83) and receiving means (20; 61a, 61b; 91; 111) are arranged on the framework (2), and an angle piece (36) for bringing about an angle between a chest support and a framework-side connection bushing (32) of said device (1), said angle piece comprising a peg (35) for insertion into the connecting bushing (32) of the framework (2), said peg being connected to a bushing (37) for insertion of the connecting peg of the chest support at an obtuse angle.
 19. A device (1) for endoscopic examinations and operations, said device comprising a framework (2) and at least one of holding means (32), connecting means (12; 83) and receiving means (20; 61a, 61b; 91; 111), for locking elements, spreading elements, lingual spatulas (15; 46a, 46b, 49; 52), labial-commissure spatulas (56a, 56b), lighting means (78), suction devices (104) for fluids, including smoke, examining instruments, including endoscopes, surgical instruments, including grasping forceps (86) and laser instruments for laser surgery and laser coagulation, wherein said holding means (32), connecting means (12; 83) and receiving means (20; 61a, 61b; 91; 111) are arranged on the framework (2), a lingual spatula (15; 46a, 46b; 49; 52) for insertion into the receiving means (20) said spatula comprising a substantially spoon-type tongue part (16; 47a, 47b; 51) and a straight holding part (18; 53) adjacent thereto which is one of not inclined and only slightly inclined in relation to the tongue part (16; 47a, 47b; 51), the entire lingual spatula (16; 46a, 46b; 49; 52) being produced from a rigid and solid material, wherein the holding part (18; 53) comprises several teeth (44) arranged in a row along its longitudinal axis which mesh with a toothed wheel of a framework-side transmission mechanism (41, 43) with a view to longitudinal displacement (40) of the lingual spatula (15; 46a, 46b; 49; 52).
 20. The lingual spatula (46a, 46b) as claimed in claim 19, wherein the tongue part (47a, 47b) is provided with a lateral cut-out (48a, 48b) to enable examinations and operations in a lingual region.
 21. The lingual spatula (52) as claimed in claim 19, wherein the tongue part (51) is provided with a curvature in a transverse direction in such a way that lateral regions (55) of the tongue part (51) diverge upwards from a tongue.
 22. A device (1) for endoscopic examinations and operations, said device comprising a framework (2) and at least one of holding means (32), connecting means (12; 83) and receiving means (20; 61a, 61b; 91; 111), for locking elements, spreading elements, lingual spatulas (15; 46a, 46b, 49; 52), labial-commissure spatulas (56a, 56b), lighting means (78), suction devices (104) for fluids, including smoke, examining instruments, including endoscopes, surgical instruments, including grasping forceps (86) and laser instruments for laser surgery and laser coagulation, wherein said holding means (32), connecting means (12; 83) and receiving means (20; 61a, 61b; 91; 111) are arranged on the framework (2), and a toothed rack (28) with which the position of a column (21) bearing the receiving means (20) for the lingual spatula (15) is manually adjustable in relation to a guide element (22) of the attachment framework (2), a palatal plate (8) comprising a frame-element (9) with bushings arranged at its end for attaching onto free ends (13) of the attachment framework.
 23. The device as claimed in claim 22, wherein the frame-element (9) is adapted to be cranked (10) downwards on both sides with a view to receiving molar teeth and upper jaw of a patient.
 24. A device (1) for endoscopic examinations and operations, said device comprising a framework (2) and at least one of holding means (32), connecting means (12; 83) and receiving means (20; 61a, 61b; 91; 111), for locking elements, spreading elements, lingual spatulas (15; 46a, 46b, 49; 52), labial-commissure spatulas (56a, 56b), lighting means (78), suction devices (104) for fluids, including smoke, examining instruments, including endoscopes, surgical instruments, including grasping forceps (86) and laser instruments for laser surgery and laser coagulation, wherein said holding means (32), connecting means (12; 83) and receiving means (20; 61a, 61b; 91; 111) are arranged on the framework (2), and a labial-commissure spatula (56a, 56b) for use as part of said device (1) and comprising an elongated, narrow basic shape with a rounded front edge (58), a means (61a; 61b) for receiving the labial-commissure spatula (56a; 56b) and for securing the same to the attachment framework (2) of said device (1), said means comprising a sleeve-shaped element (62) which encompasses an attachment frame-element (3a; 3b) of the attachment framework (2), a clip-like element (66) with a slot (63) for insertion of the labial-commissure spatula (56a; 56b), and an adjusting means (68) arranged between said sleeve-shaped element (62) and said clip-like element (66) with a view to spreading the labial-commissure spatula (56a, 56b) apart.
 25. The labial-commissure spatula as claimed in claim 24 and produced from a flexible material.
 26. A device (1) for endoscopic examinations and operations, said device comprising a framework (2) and at least one of holding means (32), connecting means (12; 83) and receiving means (20; 61a, 61b; 91; 111), for locking elements, spreading elements, lingual spatulas (15; 46a, 46b, 49; 52), labial-commissure spatulas (56a, 56b), lighting means (78), suction devices (104) for fluids, including smoke, examining instruments, including endoscopes, surgical instruments, including grasping forceps (86) and laser instruments for laser surgery and laser coagulation, wherein said holding means (32), connecting means (12; 83) and receiving means (20; 61a, 61b; 91; 111) are arranged on the framework (2), wherein two stable frame-elements (3a, 3b) are substantially parallel to one another and are present on the attachment framework (2) for the purpose of securing displaceable connecting means (12; 83) and receiving means (61a, 61b; 91; 111), for labial-commissure spatulas (56a, 56b), lighting means (78), suction devices (104), examining instruments and/or surgical instruments (86), and means (91; 111) for receiving a suction device (104), an examining instrument and a surgical instrument (86), and for securing the same to the framework (2), said means for receiving comprising a clip-type element (100; 113) with a slot (101) for insertion of the device (104) and of the instrument (86), and a clip (92; 112) for securing to said attachment frame-element (3a; 3b) of the attachment framework (2).
 27. The lighting means (78) as claimed in claim 26, wherein the attachment clip (83) is provided with a springing element (94).
 28. The receiving means (91) as claimed in claim 26, wherein a ball and socket joint (98) is arranged between the attachment clip (92) and the slotted (101) clip element (100).
 29. The receiving means (91; 111) as claimed in claim 26, wherein the slotted clip type element (100; 113) is provided with a springing element (95; 103).
 30. A device (1) for endoscopic examinations and operations, said device comprising a framework (2) and at least one of holding means (32), connecting means (12; 83) and receiving means (20; 61a, 61b; 91; 111), for locking elements, spreading elements, lingual spatulas (15; 46a, 46b, 49; 52), labial-commissure spatulas (56a, 56b), lighting means (78), suction devices (104) for fluids, including smoke, examining instruments, including endoscopes, surgical instruments, including grasping forceps (86) and laser instruments for laser surgery and laser coagulation, wherein said holding means (32), connecting means (12; 83) and receiving means (20; 61a, 61b; 91; 111 ) are arranged on the framework (2), wherein two stable frame-elements (3a, 3b) are substantially parallel to one another and are present on the attachment framework (2) for the purpose of securing displaceable connecting means (12; 83) and receiving means (61a, 61b; 91; 111), for labial-commissure spatulas (56a, 56b) lighting means (78), suction devices (104), examining instruments and surgical instruments (86), and a lighting means (78) for use as part of said device (1) and comprising a clip (83) for securing to an attachment frame-element (3a; 3b) of the attachment framework (2), and wherein a ball and socket joint (98) is arranged between the attachment clip (83) and the lighting means (78). 